Elderly diabetic mother with gallstones

  : My mother is a seventy-two year old diabetic (insulin-dependent)who was diagnosed with gallstones approximately two years ago after she began complaining of moderate to severe stomach pain (she was experiencing the pain every day).  It is now at the point that her physician prescribed Hyoscyamine four times a day for the pain.  The medication only provides mom with some relief (the pain never completely goes away).
  : Her physician stated that the only other alternative is surgery; I always thought that any surgery performed on a diabetic is risky due to the high risk of infection (gangrene for example).  In addition, my mother is an UNHEALTHY diabetic (5'3" tall, 201 lbs. and is hospitalized for various ailments once in every eighteen month period (last hospitalized for pneumonia in early 1997). Note: She takes two types of insulin every day - a total of 30 units of Humulin N and a total of 19 units of Humalog.
  : Are there any other alternatives to surgery?
  : What is the mortality rate of elderly people with regard to gall bladder surgery?
  : What problems are likely to occur with a diabetic who undergoes gall bladder surgery?
  : HELP!
Dear Jan,
In the past, it had been recommended that diabetics undergo prophylactic cholecystectomy (surgical removal of the gallbladder) for gallstones because of the high risk of acute cholecystitis (gallbladder infection). This is no longer routinely recommended. Patients with acute cholecystitis should be treated with surgery once stabilized. In patients with biliary pain and documented gallstones (with ultrasound) or cholecystitis (with HIDA scan) surgery is still considered the treatment of choice. It is now possible to perform cholecystectomy via the laparoscope. Laparoscopic cholecystectomy allows for a reduced hospital stay, easier recovery, earlier return to normal activities, smaller scar and better patient satisfaction. In elderly patients with comorbid conditions (who don't have acute cholecystitis) who present high surgical risks oral bile acid therapy with ursodeoxycholic acid (Actigall) is an option. Surgical removal clears stones in 100% of patients while oral therapy clears stones in 40-90% of patients after six months to one year of treatment. There is also a 50% recurrence rate with oral therapy. Mortality rates for open cholecystectomy and laparoscopic cholecystectomy range between 2% (high risk patients). I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you want to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: elderly, diabetic, gallstones, surgery, medical management